1400 Abstracts 6.

TBB IMPORTANCE OF THE FAMILY HISTORY IN BWAST CANCER. 1

Weber W. , Ott J. 2 and Mller Sj.1 1 Laboratory of Hums" Genetics, Department of Research, Uni- versity Clinics, Cantnnal Hospital, CH-4031 Basel,Switzerland. 2 vice Director, Statistical office of the City of Zorich, Switzerland.

Pedigree data are systematically collected from patients with newly diagnosed malignant diseases in hospital services and private practice in Basel. A registry for cancer-prone fsmi- lies is established.

A" excessive accumulation of breast cancer was observed in the families of 3 of 30 interviewed female breast cancer pa- tients. In 2 other families breast cancer was associated with adenocarcinomas of different organs. Healthy female relatives of breast cancer patients have repeatedly consulted us for advice on the value and risk of prophylactic mastectomy.

Our preliminary data are in agreement with the results repor- ted by Dr. H.T. Lynch who has show" that a family history coupled with histologic verification can provide the physi- cian a powerful tool for the identification of patients gene- tically susceptible to cancer (JAMA 242: 1268-1272, 1979).

7.

HISTOPATHOLOGICAL RISK EVALUATION IN BREAST CANCER. K.Biirki, A.Zimmermann, R.Kraft, B.Roos. Institute of Pa- thology, University of -Ii-Eern, Switzerland.

The diagnosis "breast cancer" ss such does not suffice for clinicopathologicsl evaluation since it covers different diseases in different stages of development. In fact, inhe- rent pathological and biological characteristics of various types of mammary cancer srs not only of importance for progno- sis; in at least a number of csses they can also influence the therapist's management. Pathological parameters determin- ing prognosis comprise: degree ana pattern of spreading, in particular to regional lymph "odes; primary tumor size; dif- ferentiation (i.e. histological snd nuclear grade); histolo- gical type of the tumor, tumor necrosis, border (circum- scribed or stellate) and vascular invasion; primary site; "biochemicsl' character (including hormonal responsiveness); multicentricity etc. Current classifications of breast cancer s.re based on morphologic descriptive and/or presumed histoge- netic criteria. Several reports attest the favorable clinical course of certain histologic types, Viz. medullary, tubular, mutinous, comedo and adenoid cystic carcinomas as compared to other types. The significance of so-called carcinomas in situ -- is still disputed. Risk evaluation seems to be mnre reliable if histological typing and grading s.re combined with parsme- ters mentioned above, particularly on the extent of the dis- ease. Additional parameters such as cellular kinetics, cell sizing, elastosis in the tUrnOr bed, tumor-host interactions (including specific immune reactions and "on-specific host re- sistance) have met with increasing interest in recent years. The prognostic usefulness of snme of these complementary ps- rameters remains to be examined in more detail.

8.

INFLUENCE OF THE INTERNAL MAMMARY LYMPHNODES (IML) ON LONG TERM SURVIVAL (20 & 25 YEARS) IN WOWiN WITH BREAST CANCER. R.A.Egsli and J.A.Urban, MSicCC, New York, N.Y. 10021, USA.

A series of 784 patients with breast cancer who underwent extended radical ma&e&any is presented. Most often the tumor wss located either in the inner quadrants (88 %) or central (8 %). A postsurgical analysis of the axillary lymph- nodes (AL) and the II& revealed that the AL were positive in 44 \ of all the cases and the IML in 30 %. In 15 % the IML were found to bs involved by metastatic spread when the AL

were negative. 155 pts were eligible for a 25 year survival analysisi of these 50 8 died of disease KXJD1 and 22 \ were still alive without any signe of disease (NED) 25 years after the operation. 327 pts were available for s 20 year survival analysis; of these 43 8 were COD and 30 8 NED.

R careful analysis of the survival rates with regard to lymph- node involvement shows the following result :

25 yeses 20 years NED DOD NED DOD

AL neg/1uL neg 33 \ 33 \ 44 a 2Q % AL pos/1ML neg 21 \ 53 \ 21 % 44 % AL neq/1ML pas 11 % 56 li 30 % 48 % RL pos/1ML pas 12 8 73 % 13 % 74 $

Today we depend for the treatment (adjuvant or complementa- ry) on an exact staging of the AL. But where is the place of the surgico-pathological staging of the IML ? Is there the missing link that would explain the decrease in expected survival rates for low stage breast cancer ?

9.

PRDGNDSTIC FACTORS FOR THE COURSE OF METASTATIC BREAST CANCER. K.W.Brunner, M.F.Fey, Institute for Medical O"col"qy, 1nse1spita1, CH-3010 Bern.

Various factors determining total survival from the time of initial diagnosis, the median survival after appearance of metsstases and survival from the onset of chemotherapy were studied in 405 patients treated in SAKK protocols between 1968 snd 1976. The site of the first metsstatic lesion seems to be a" important factor in regard t" overall survival from the time of diagnosis. Four categories of metaststic types could be established with significantly different median survival times. According t" the category, total survival varied from 19 to 58 months.

Differences in survival times after appearance of the first metastasis, or following institution of chemotherapy were much less pronounced. These were determined primarily by 3 types of metastases as well as the time interval from the Very first treatment to the first metastasis, but espe- cially by the response t" treatment in the metsstatic phase of disease. Factors which clearly influenced the cnurse of metastatic disease in the past are rapidly losing their significance in the face of modern chemotherapy. It appears that the mnst important effect of chemotherapy is tc improve the median survival of prognostically unfavorable cases so the course approaches that of patients with a spontaneous favorable course of disease.

IO.

OESTROGEN AND PROGESTERONE RECEPTORS IN BREAST CANCER CLINICAL CORRELATION AND PROGNOSTIC SIGNIFICANCE AFTER 3 YEARS EXPERIENCE. G. Ross&, C. Depierre, C. Guelpa and R. Egeli, H6pital Cantonal UNiversitaire, 1211 Geneva 4, Switzerland. The interest for hormonal receptors measurements in select- ing patients for endocrine therapy is well established. Several authors have also reported on the relation between absence of receptors and bad prognosis.

We measured oestrogen and progesterone receptors in 600 patients with breast cancer for the last three years. The method used was the Dextran-coated charcoal assay.

Survival rate without relapse in patients with oestrogen receptors is 07 % with a follow up period ranging from 12 to 36 nmnths. In the absence of oestrogen receptors the survival rate without relapse falls to 65 % for the same period of observation, regardless of TNM staging. In our series death rate of patients without oestrogen receptors is 23 % compared to only 4 % in patients with oestrogen receptors. Relations between presence or absence of hormonal receptors regarding to clinical staging, tumor histology, menopausal status have also been analysed. This study was partly supported by the Geneva League Against Cancer and by the Swiss Group (SAKK).